- Slow growing = identified late
- Initially, pt has asymptomatic symptoms
- Later develops swelling due to buccolingual expansion and come to dentist
- Mandible = posterior = Ramus/body = mc
- If it occurs in anterior region = desmoplastic type = aggressive and resembles fibro osseous lesion
- 20% of cases seen in maxilla = can involve sinus
- Epicenter = odontogenic in origin = above IAC
- Size = large, diffuse
- Borders = well defined
- Internal structure =
- septa are small and round = honeycomb appearance
- Septa are large and round = soap bubble appearance
- Septa are curved and round
- Displace IAC inferiorly
- Root resorption = Knife edge resorption
- Lower border of mandible = thin egg shell appearance due to aggressive expansion
- Acute periapical abscess
- Vertical pain = tenderness on percussion
- Vestibular tenderness and obliteration = pathognomonic sign
- Widening of PDL = Only feature. It takes time for r/g features to develop, by that time acute has been converted into chronic
- Chronic Periapical abscess
- Carious tooth
- Sinus tract = pus will come out
- Hence, there will be a breach in the continuity of lamina dura
- Diffuse, ill-defined radiolucency surrounding root apex
- Periapical Granuloma
- Granuloma is made up of granulation tissue. It is formed due to new vascularizations.
- May or maynot be corticated
- Size is less than 1.5 cm in diameter
- Well defined
- Periapical cyst
- Well defined
- Surrounding corticated or sclerotic border
- Size is more than 1.5 cm
- Infected Cyst
- Partially well defined
- Corticated border = evident only in few areas
- PERIAPICAL CEMENTAL DYSPLASIA 2M*
- Site = mandibular anteriors
- Teeth = vital
- Appearing as periapical radiolucency
- RL = initial stage
- Mixed = intermediate stage
- RO = mature stage
- Phoenix abscess
- Acute exacerbated phases of chronic periapical abscess
- Pt complains that Every 6 months, swelling and pain
- Pulp is non vital
- Lateral periodontal Cyst
An 11-year-old female presented with a class II division 1 malocclusion on a moderate skeletal class II pattern with reduced vertical dimensions complicated by an increased overjet (11mm), increased overbite, generalized spacing and bi-maxillary proclination.
The aetiology of this malocclusion is multi-factorial.
The moderate skeletal class II discrepancy resulted in an increased overjet and class II molar relationship. The overjet was exacerbated by the presence of a lower lip trap. The generalized spacing was a result of an underlying dento-alveolar disproportion. This was compounded by bi-maxillary proclination, which arose due to resting soft tissue pressures and dento-alveolar compensation.
• Integration of twin block functional and sectional lower fixed Herbst appliancee
• Continuation of functional appliance wear at night
• Use of headgear
• Inter-arch class II elastic traction following fixed
The prognosis for long-term stability of class II correction is good in this case, as the new maxillary incisor position will be controlled by the lower lip following the achievement of lip competence.
A 12-year-old female presented with a class II division 1 malocclusion on a moderate skeletal class II pattern, with increased vertical dimensions complicated by an increased overjet (12mm), crowding of both dental arches and teasing in relation to her dento-facial appearance.
What is treatment plan?
1) Functional appliance like Dynamax or Twin block (more preffered as overjet reduction is more effective) = maxillary retroclination, mandibular incisor proclination, guides the eruption of posterior dentition.
2) Need of Headgear with torqueing spurs = restricts maxillary forward growth and tipping of maxillary incisors.
3) Extraction of four second premolars followed by edge to edge appliances for stability of class II correction.
Highly elevated alkaline phosphatase is a good marker of Paget’s disease of bone in the appropriate clinical setting. Bone sequestration is often secondary to chronic osteomyelitis in the jaws. Bisphosphonates are used to treat Paget’s disease and also have been linked to jaw osteonecrosis.
Study the two radiographs which are of the same
patient at (a) 19 years and (b) 34 years of age.
1 . What is the most likely periodontal diagnosis at 34
years of age?
Generalised aggressive periodontitis. The severity
of bone resorption and the radiographic absence of
signs of resorption at 19 years preclude a diagnosis of
2 . What does the initial phase of treatment involve?
Initially conventional cause-related treatment
is instigated: instruction in toothbrushing and
use of adjunctive aids for interproximal and
subgingival cleaning, RSI, prophylaxis. Ultimately,
treatments such as surgery and the adjunctive use of
antimicrobials might be indicated, but conventional
treatment is first in line.
3 . The patient has a sister who is aged 29 years. What
advice might you offer?
Periodontal screening and radiographic examination.
There is evidence that certain subjects are at high risk
from developing aggressive periodontitis and this
risk may be under genetic control. Siblings should
be screened and affected individuals with children
warned that early signs may develop from around
A 35-year-old man presents with gross loosening of both his lower left premolar teeth. The gingiva around them looks swollen and is purple–brown in colour. A radiograph shows irregular bone destruction to the apices. Incisional biopsy shows multinucleated osteoclast-like giant cells in a haemorrhagic fibrous stroma.
- Which investigations should now be performed?
The serum calcium level should be measured and radiographs reviewed to exclude hyperparathyroidism.
- If these prove negative, what treatment should be undertaken?
The lesion should be treated by local removal with curettage.
- Which other lesions in the jaws contain multinucleate giant cells of this type?
Osteoclast-like giant cells are found in
- giant-cell granuloma
- brown tumour of hyperparathyroidism
- Pagetʼs disease of bone
- aneurysmal bone cyst
- some fibro-osseous lesions, particularly cherubism.
A 60-year-old man has been treated for a T2N0M0 squamous-cell carcinoma by radical radiotherapy. He has a history of chronic alcoholism and was a heavy smoker. Six years after treatment, he develops a painful ulcer in the alveolar mucosa in the treated area following minor trauma. His pain worsens and the bone became progressively exposed. He is treated by a partial mandibular resection with graft.
- What diagnosis is most likely?
The features suggest osteoradionecrosis. Recurrent carcinoma is possible but less likely.
- How does radiotherapy damage tissues and what structural features might be seen in the bone?
Radiotherapy damages tissues by producing free radicals. DNA damage may prevent cell division and repair. Endoarteritis obliterans results in reduced vascular supply to the tissues. Bone may become necrotic, showing osteocyte death, sequestration and breakdown of the matrix. Infection may result in osteomyelitis
- What changes may arise in irradiated connective tissues 10 years after exposure?
Mutations and other genetic damage may lead to neoplasia in irradiated tissues. Osteosarcoma can arise in this way.
A 58-year-old woman noticed that her front teeth had become spaced and seeks advice from her dentist. On entering the surgery, the dentist notices that she has difficulty in walking and does not respond to his questions. She has become increasingly deaf and her vision has also deteriorated. On examination, the maxilla and zygoma are enlarged and there is enlargement of the forehead.
1. What diagnosis would you suspect?
Pagetʼs disease of bone results in enlargement of cranial bones and deformation of weight- bearing bones. The cranium is usually expanded in thickness and symptoms may arise from cranial nerve compression.
2. What information might be gained from oral radiographs and blood tests to support this diagnosis?
Radiographs of the jaws may show hypercementosis, cemental masses, abnormal trabeculation and a cotton-wool appearance in the jaws. The alkaline phosphatase level is markedly raised.
3. What are the principal histological features of this disorder?
Disordered bone remodelling is seen; larger osteoclasts are present and the trabeculae show a scalloped outline. Numerous resting and reversal lines, resulting in a mosaic pattern, are seen and the vasculature may be increased. Globular cementum-like masses are seen in the jaws.